Heart Rate Problems: Should I Get a Pacemaker?

Heart Rate Problems: Should I Get a Pacemaker?

You may want to have a say in this decision, or you may simply want to follow your
doctor's recommendation. Either way, this information will help you understand what
your choices are so that you can talk to your doctor about them.

Heart Rate Problems: Should I Get a Pacemaker?

1

Get theFacts

2

CompareOptions

3

YourFeelings

4

Get theFacts

5

QuizYourself

6

Your Summary

Get the facts

Your options

Get a pacemaker.

Don't get a pacemaker.

This decision aid is NOT for people with heart failure. The decision for heart failure patients may involve a special type of pacemaker (cardiac resynchronization therapy) and may
raise other issues to think about.

Key points to remember

A pacemaker can help you feel better so you can return to your daily activities.

A pacemaker sends electrical pulses to your heart to help it work better. You can't
feel the pulses.

If you get a pacemaker, you may still need to take medicines. You'll also need to
follow a healthy lifestyle to help your heart. Eat heart-healthy foods, and don't
smoke.

Heart experts have guidelines about who might need a pacemaker. Talk to your doctor
about the reasons that you might need one. For example, a pacemaker may be a good
choice if your heart rate is very slow and you have symptoms like dizziness or fainting.

There can be problems from the procedure to implant a pacemaker. You could get an
infection where the pacemaker was placed. Most pacemakers have wires (called leads)
that connect the pacemaker to your heart. These wires can move from the spot where
they were placed. Or the pacemaker or leads might not work.

Pacemakers are small electrical devices that help control the timing of your heartbeat. The
pacemaker sends out mild electrical pulses that keep your heart beating normally.

Most pacemakers are implanted under the skin of your chest wall. These pacemakers
have wires that pass through a vein into the chambers of your heart. Some pacemakers
are placed inside the heart and do not have wires.

There are different types of pacemakers, so your doctor will work with you to decide
what kind will be best for you.

The procedure to implant a pacemaker is considered minor surgery. It can usually be
done using local anesthesia. Your doctor will make a small incision in your chest
wall just below your collarbone. The doctor puts the leads in a vein and threads them
to the heart. Then your doctor connects the leads to the pacemaker. Your doctor programs
the pacemaker and then puts it in your chest and closes the incision. You may be able
to see a little bump under the skin where the pacemaker is placed.

Some pacemakers don't have leads that connect to the heart. These leadless pacemakers
are placed directly inside the heart.

To implant a leadless pacemaker, the doctor uses a thin tube called a catheter. The
pacemaker is placed inside the catheter. He or she puts the catheter into a blood
vessel in your groin. You will get a shot to numb the skin where the catheter goes
in. Then the doctor moves the catheter through the blood vessel to a lower chamber
of your heart. The doctor moves the pacemaker out of the catheter. He or she attaches
the pacemaker to the heart tissue. Then the catheter is removed from your body.

Most people spend the night in the hospital, just to make sure that the device is
working and that there are no problems from the surgery. But sometimes the procedure
is done as an outpatient procedure, which means you don't need to stay overnight in
the hospital.

There are several risks to getting a pacemaker. But risks vary for each person. And
risks vary based on the type of pacemaker you get. The chance of most problems is
low.

The procedure to implant a pacemaker is safe, and most people do well afterward. Afterward,
you will see your doctor regularly to get your pacemaker checked and to make sure
you don't have any problems.

During the procedure. If problems happen during the procedure, doctors likely can fix them right away.
Examples include:

A lung could collapse (pneumothorax). This happens if air builds up in the space between
the lung and the chest wall. But a pneumothorax can be treated and people recover
well. This problem may happen about 1 to 5 times out of a 100.footnote 1

A tear in the heart could happen. Or a person might need emergency medicine or surgery.
Based on rates of complications from patients, these problems happen about 1 time
out of 100. So about 99 times out of 100, these problems do not happen.footnote 2

After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection.
But your doctor can solve most of these problems. And most people do not have long-term
issues with their pacemakers.

Problems include:

Pain, bleeding, or bruising soon after the procedure.

Blood clots in your arms, which cause a lot of swelling.

Infection in your chest near the pacemaker. An infection might happen about 1 time
out of 100. This means that about 99 times out of 100 there is no infection.footnote 3

Device problems that need another procedure to fix them. For example, this might happen
if a pacemaker lead breaks or a lead moves out of place.

Daily precautions. You'll need to use certain electric devices with caution. Some electric devices have
a strong electromagnetic field. This field can keep your pacemaker from working right
for a short time. Check with your doctor about what you need to avoid and what you
need to keep a short distance away from your pacemaker. Many household and office
electronics do not affect your pacemaker.

You have a problem with your heart rate that could be helped by a pacemaker.

You have trouble doing everyday activities, or you can't do them at all.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Get a pacemaker Get a pacemaker

You will have minor surgery or a procedure to have the pacemaker put in. The doctor
will numb the area so you won't feel pain.

You may spend the night in the hospital to make sure that the device is working and
that there are no problems.

You will need regular checkups to make sure that the pacemaker is working and to adjust
the pacing, if needed.

You may still need to take medicines for your heart rate problem.

You still have to eat healthy foods and to exercise as your doctor advises.

A pacemaker can help you feel better so you can be more active.

If you have a certain type of heart block, a pacemaker may help prevent a dangerously
slow heart rate and may help you live longer.

Problems can happen during the procedure to place the pacemaker or soon after the
procedure. One example is a lung collapsing.

There might be problems with the pacemaker. Examples include the leads breaking or
an infection.

You need to avoid devices that have strong magnetic or electrical fields, because
they could stop the pacemaker from working. But most everyday appliances and electronic
devices are safe.

You will need surgery to replace the battery, which may last about 8 to 10 years.

Don't get a pacemaker Don't get a pacemaker

You take medicines for whatever disease is causing your heart rate problem.

You eat healthy foods, and you exercise as your doctor advises.

You see your doctor regularly to check your symptoms and how your medicine is working.

You won't have the risk of infection or other problems from the surgery.

You won't have to think about safety around devices that could stop your pacemaker
from working.

Your symptoms could get worse. This would limit your ability to do your daily activities.

You might be at risk for fainting or falling, which could be dangerous.

Personal stories about considering a pacemaker

These stories are based on information gathered from health professionals and consumers.
They may be helpful as you make important health decisions.

I have a hard time getting my chores done around the house or going grocery shopping.
I get really short of breath after walking for a few minutes. My doctor says a pacemaker
could help me feel better.

Jack, age 66

My doctor says my heart rate is slow. But I can still work and take my daily walks
with no problem. I'm not ready to get a pacemaker. I'll keep taking my medicine and
following my diet.

Serena, age 55

I get dizzy sometimes, and my doctor says I have a slow heart rate that could lead
to serious problems. She says a pacemaker can help keep that from happening. It's
minor surgery, so I'm choosing the pacemaker.

Shaun, age 75

I'm not very active, and I'm really afraid of surgery and of having something mechanical
in my body. I don't want to get a pacemaker.

James, age 83

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what
matters most to you in this decision, and show how you feel about the following statements.

Reasons to get a pacemaker

Reasons not to get a pacemaker

I want to feel better so that I can do my daily activities.

I'm not having too much trouble doing my daily activities.

More important

Equally important

More important

I don't mind having a device in my body.

I don't like the idea of having a device in my body.

More important

Equally important

More important

My medicines aren't controlling my symptoms anymore.

My symptoms aren't getting worse.

More important

Equally important

More important

I'm not worried about risks from surgery, because they're small.

I don't want to take a chance that something could go wrong during surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general
idea of where you stand on this decision. Show which way you are leaning right now.

Getting a pacemaker

NOT getting a pacemaker

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, If I get a pacemaker, I still need to follow a healthy lifestyle.

TrueYou're right. You still need to follow a healthy lifestyle. Eat heart-healthy foods,
and don't smoke.

FalseSorry, that's not right. You still need to follow a healthy lifestyle. Eat heart-healthy
foods, and don't smoke.

I'm not sure It may help to go back and read "Get the Facts." You still need to follow a healthy
lifestyle.

2.2, I don't need a pacemaker if I don't have any symptoms.

TrueSorry, that's not right. Some people with no symptoms are still at risk of getting
a dangerously slow heart rate in the future. A pacemaker may be used to help prevent
that.

FalseYou're right. Some people with no symptoms are still at risk of getting a dangerously
slow heart rate in the future. A pacemaker may be used to help prevent that.

I'm not sure It may help to go back and read "Get the Facts."Some people with no symptoms are
still at risk of getting a dangerously slow heart rate in the future. A pacemaker
may be used to help prevent that.

You may want to have a say in this decision, or you may simply want to follow your
doctor's recommendation. Either way, this information will help you understand what
your choices are so that you can talk to your doctor about them.

Heart Rate Problems: Should I Get a Pacemaker?

Here's a record of your answers. You can use it to talk with your doctor or loved
ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Get a pacemaker.

Don't get a pacemaker.

This decision aid is NOT for people with heart failure. The decision for heart failure patients may involve a special type of pacemaker (cardiac resynchronization therapy) and may
raise other issues to think about.

Key points to remember

A pacemaker can help you feel better so you can return to your daily activities.

A pacemaker sends electrical pulses to your heart to help it work better. You can't
feel the pulses.

If you get a pacemaker, you may still need to take medicines. You'll also need to
follow a healthy lifestyle to help your heart. Eat heart-healthy foods, and don't
smoke.

Heart experts have guidelines about who might need a pacemaker. Talk to your doctor
about the reasons that you might need one. For example, a pacemaker may be a good
choice if your heart rate is very slow and you have symptoms like dizziness or fainting.

There can be problems from the procedure to implant a pacemaker. You could get an
infection where the pacemaker was placed. Most pacemakers have wires (called leads)
that connect the pacemaker to your heart. These wires can move from the spot where
they were placed. Or the pacemaker or leads might not work.

FAQs

What is a pacemaker?

Pacemakers are small electrical devices that help control the timing of your heartbeat. The
pacemaker sends out mild electrical pulses that keep your heart beating normally.

Most pacemakers are implanted under the skin of your chest wall. These pacemakers
have wires that pass through a vein into the chambers of your heart. Some pacemakers
are placed inside the heart and do not have wires.

There are different types of pacemakers, so your doctor will work with you to decide
what kind will be best for you.

What heart rate problems can a pacemaker help?

A pacemaker can help restore a normal heart rate when certain problems have damaged
the heart's electrical system , which normally keeps your heart beating steadily. These problems include:

Changes in the heart that are the result of aging.

Coronary artery disease.

Heart attack.

Heart block (such as an AV block), which is an abnormality in the way electricity
passes through the heart's normal electrical pathways.

Pacemakers allow people to return to normal, active lives. Most people have very few
limitations, if any.

How is a pacemaker placed?

Most pacemakers are surgically implanted under the skin of the chest.

The procedure to implant a pacemaker is considered minor surgery. It can usually be
done using local anesthesia. Your doctor will make a small incision in your chest
wall just below your collarbone. The doctor puts the leads in a vein and threads them
to the heart. Then your doctor connects the leads to the pacemaker. Your doctor programs
the pacemaker and then puts it in your chest and closes the incision. You may be able
to see a little bump under the skin where the pacemaker is placed.

Some pacemakers don't have leads that connect to the heart. These leadless pacemakers
are placed directly inside the heart.

To implant a leadless pacemaker, the doctor uses a thin tube called a catheter. The
pacemaker is placed inside the catheter. He or she puts the catheter into a blood
vessel in your groin. You will get a shot to numb the skin where the catheter goes
in. Then the doctor moves the catheter through the blood vessel to a lower chamber
of your heart. The doctor moves the pacemaker out of the catheter. He or she attaches
the pacemaker to the heart tissue. Then the catheter is removed from your body.

Most people spend the night in the hospital, just to make sure that the device is
working and that there are no problems from the surgery. But sometimes the procedure
is done as an outpatient procedure, which means you don't need to stay overnight in
the hospital.

What are the risks?

There are several risks to getting a pacemaker. But risks vary for each person. And
risks vary based on the type of pacemaker you get. The chance of most problems is
low.

The procedure to implant a pacemaker is safe, and most people do well afterward. Afterward,
you will see your doctor regularly to get your pacemaker checked and to make sure
you don't have any problems.

During the procedure. If problems happen during the procedure, doctors likely can fix them right away.
Examples include:

A lung could collapse (pneumothorax). This happens if air builds up in the space between
the lung and the chest wall. But a pneumothorax can be treated and people recover
well. This problem may happen about 1 to 5 times out of a 100.1

A tear in the heart could happen. Or a person might need emergency medicine or surgery.
Based on rates of complications from patients, these problems happen about 1 time
out of 100. So about 99 times out of 100, these problems do not happen.2

After the procedure. Problems after the procedure can be minor, like mild pain, or serious, like an infection.
But your doctor can solve most of these problems. And most people do not have long-term
issues with their pacemakers.

Problems include:

Pain, bleeding, or bruising soon after the procedure.

Blood clots in your arms, which cause a lot of swelling.

Infection in your chest near the pacemaker. An infection might happen about 1 time
out of 100. This means that about 99 times out of 100 there is no infection.3

Device problems that need another procedure to fix them. For example, this might happen
if a pacemaker lead breaks or a lead moves out of place.

Daily precautions. You'll need to use certain electric devices with caution. Some electric devices have
a strong electromagnetic field. This field can keep your pacemaker from working right
for a short time. Check with your doctor about what you need to avoid and what you
need to keep a short distance away from your pacemaker. Many household and office
electronics do not affect your pacemaker.

Why might your doctor recommend a pacemaker for a heart rate problem?

Your doctor might recommend that you get a pacemaker if:

You have a problem with your heart rate that could be helped by a pacemaker.

You have trouble doing everyday activities, or you can't do them at all.

2. Compare your options

Get a pacemaker

Don't get a pacemaker

What is usually involved?

You will have minor surgery or a procedure to have the pacemaker put in. The doctor
will numb the area so you won't feel pain.

You may spend the night in the hospital to make sure that the device is working and
that there are no problems.

You will need regular checkups to make sure that the pacemaker is working and to adjust
the pacing, if needed.

You may still need to take medicines for your heart rate problem.

You still have to eat healthy foods and to exercise as your doctor advises.

You take medicines for whatever disease is causing your heart rate problem.

You eat healthy foods, and you exercise as your doctor advises.

You see your doctor regularly to check your symptoms and how your medicine is working.

What are the benefits?

A pacemaker can help you feel better so you can be more active.

If you have a certain type of heart block, a pacemaker may help prevent a dangerously
slow heart rate and may help you live longer.

You won't have the risk of infection or other problems from the surgery.

You won't have to think about safety around devices that could stop your pacemaker
from working.

What are the risks and side effects?

Problems can happen during the procedure to place the pacemaker or soon after the
procedure. One example is a lung collapsing.

There might be problems with the pacemaker. Examples include the leads breaking or
an infection.

You need to avoid devices that have strong magnetic or electrical fields, because
they could stop the pacemaker from working. But most everyday appliances and electronic
devices are safe.

You will need surgery to replace the battery, which may last about 8 to 10 years.

Your symptoms could get worse. This would limit your ability to do your daily activities.

You might be at risk for fainting or falling, which could be dangerous.

Personal stories

Personal stories about considering a pacemaker

These stories are based on information gathered from health professionals and consumers.
They may be helpful as you make important health decisions.

"I have a hard time getting my chores done around the house or going grocery shopping.
I get really short of breath after walking for a few minutes. My doctor says a pacemaker
could help me feel better."

— Jack, age 66

"My doctor says my heart rate is slow. But I can still work and take my daily walks
with no problem. I'm not ready to get a pacemaker. I'll keep taking my medicine and
following my diet."

— Serena, age 55

"I get dizzy sometimes, and my doctor says I have a slow heart rate that could lead
to serious problems. She says a pacemaker can help keep that from happening. It's
minor surgery, so I'm choosing the pacemaker."

— Shaun, age 75

"I'm not very active, and I'm really afraid of surgery and of having something mechanical
in my body. I don't want to get a pacemaker."

— James, age 83

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what
matters most to you in this decision, and show how you feel about the following statements.

Reasons to get a pacemaker

Reasons not to get a pacemaker

I want to feel better so that I can do my daily activities.

I'm not having too much trouble doing my daily activities.

More important

Equally important

More important

I don't mind having a device in my body.

I don't like the idea of having a device in my body.

More important

Equally important

More important

My medicines aren't controlling my symptoms anymore.

My symptoms aren't getting worse.

More important

Equally important

More important

I'm not worried about risks from surgery, because they're small.

I don't want to take a chance that something could go wrong during surgery.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general
idea of where you stand on this decision. Show which way you are leaning right now.

Getting a pacemaker

NOT getting a pacemaker

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1. If I get a pacemaker, I still need to follow a healthy lifestyle.

True

False

I'm not sure

You're right. You still need to follow a healthy lifestyle. Eat heart-healthy foods,
and don't smoke.

2. I don't need a pacemaker if I don't have any symptoms.

True

False

I'm not sure

You're right. Some people with no symptoms are still at risk of getting a dangerously
slow heart rate in the future. A pacemaker may be used to help prevent that.

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